Healthcare Provider Details

I. General information

NPI: 1386702157
Provider Name (Legal Business Name): ROBERT J WALSH MD, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 N MARCEY ST SUITE 530
CHICAGO IL
60614-5373
US

IV. Provider business mailing address

1731 N MARCEY ST SUITE 530
CHICAGO IL
60614-5373
US

V. Phone/Fax

Practice location:
  • Phone: 312-867-7090
  • Fax: 312-867-7081
Mailing address:
  • Phone: 800-611-6912
  • Fax: 440-716-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT J WALSH
Title or Position: PRESIDENT
Credential: MD
Phone: 312-867-7090